Schizotypal personality disorder

Background

• A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior

Clinical Features

• Five (or more) of the following criteria, beginning in early adulthood and present in a variety of contexts:
  • Ideas of reference (excluding delusions of reference).
  • Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”: in children and adolescents, bizarre fantasies or preoccupations).
  • Unusual perceptual experiences, including bodily illusions.
  • Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
  • Suspiciousness or paranoid ideation.
  • Inappropriate or constricted affect.
  • Behavior or appearance that is odd, eccentric, or peculiar.
  • Lack of close friends or confidants other than first-degree relatives.
  • Excessive social anxiety that does not diminish with familiarity and tends to be as­sociated with paranoid fears rather than negative judgments about self.
• Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder

Differential Diagnosis

Psychiatric Disorders with Psychotic Symptoms

• Acute psychosis
• Schizophrenia
• Schizoaffective disorder
• Delusional disorder
• Schizotypal personality disorder
• Schizoid personality disorder
• Bipolar disorder with psychotic features

Other

• Neurodevelopmental disorders
• Personality change due to another medical condition
• Substance use disorders
• Other personality disorders and personality traits

Evaluation

• A clinical diagnosis; however if entertaining other organic causes may initiate workup below

General ED Psychiatric Workup

• Point-of-care glucose
• CBC
• Chem 7
• LFTs
• ECG (for toxicology evaluation)
• ASA level
• Tylenol level
• Urine toxicology screen/Blood toxicology screen
• EtOH
• Urine pregnancy/beta-hCG (if female of childbearing age)
• Consider:
  • Ammonia (see Hepatic encephalopathy)
  • TSH (hypo or hyperthyroidism may mimic mental illness)
  • CXR (for Tb screen or rule-out delirium in older patient)
  • UA (for rule-out delirium in older patients)
  • Head CT (to rule-out ICH in patients with AMS)
  • Lumbar puncture (to rule-out meningitis or encephalitis)

Management

• Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, and anti-psychotics medications

Disposition

• Discharge

See Also

• Personality disorders